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Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria
Abstract
Objectives To describe and validate the Athens Insomnia Scale (AIS).Methods The AIS is a self-assessment psychometric instrument designed for quantifying sleep difficulty based on the ICD-10 criteria. It consists of eight items: the first five pertain to sleep induction, awakenings during the night, final awakening, total sleep duration, and sleep quality; while the last three refer to well-being, functioning capacity, and sleepiness during the day. Either the entire eight-item scale (AIS-8) or the brief five-item version (AIS-5), which contains only the first five items, can be utilized. The validation of the AIS was based on its administration to 299 subjects: 105 primary insomniacs, 144 psychiatric patients and 50 non-patient controls.Results Regarding internal consistency, for both versions of the scale, the Cronbach's alpha was around 0. 90 and the mean item-total correlation coefficient was about 0.70. Moreover, in the factor analysis, the scale emerged as a sole component. The test-retest reliability correlation coefficient was found almost 0.90 at a 1-week interval. As far as external validity is concerned, the correlations of the AIS-8 and AIS-5 with the Sleep Problems Scale were 0.90 and 0.85, respectively.Conclusion The high measures of consistency, reliability, and validity of the AIS make it an invaluable tool in sleep research and clinical practice.
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“For example, questionnaire measures of insomnia commonly include both nocturnal and daytime symptoms [54,55,61].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [55]
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“AIS is a scale developed in accordance with the diagnostic criteria for insomnia in the International Classification of Disorders (ICD-10), and its Japanese version has been verified and validated by Okajima et al [19,20].”
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“For lifestyle factors, we evaluated body mass index, smoking history, drinking history, history of keeping pets (dogs and cats), family history of IBD, exercise habits, and Athens insomnia scale (AIS) [20], Center for Epidemiological Studies Depression [21], and K-6 questionnaire scores [22].”
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Otsuka, Y., Takeshima, O., Itani, O., Kaneko, Y., Suzuki, M., Matsumoto, Y., & Kaneita, Y. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.11.056 · Cited by 7
Hirose, A., Terauchi, M., Odai, T., Fudono, A., Tsurane, K., Sekiguchi, M., Iwata, M., Anzai, T., Takahashi, K., & Miyasaka, N. (2023) · International Journal of Women’s Dermatology · doi:10.1097/jw9.0000000000000084 · Cited by 7
Dermanowski, M. M., Wichniak, A., Hejduk, A., Kuczyńska, J., Dominiak, M., & Mierzejewski, P. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12247757 · Cited by 7
“Each participant was asked to complete the following clinical scales: the Athens Insomnia Scale (AIS) [27,28], Insomnia Severity Index (ISI) [29], Epworth Sleepiness Scale (ESS) [30], and chronotype questionnaires: the Morningness–Eveningness Questionnaire (MEQ) [31,32] and the Composite Scale of…”
MethodAlshehri, G. D., Almahmoudi, A., Alsaif, A. A., Shalabi, B., Fatani, H. Z., Aljassas, F. H., Alsulami, D. W., Alhejaili, F. F., & Zawawi, F. (2024) · International Archives of Otorhinolaryngology · doi:10.1055/s-0043-1776731 · Cited by 7
Depressive symptoms, sleep-wake features, and insomnia among female students: The role of rumination
Zhang, X., Wang, F., Zou, L., & Lee, S. (2024) · Journal of Health Psychology · doi:10.1177/13591053241258252 · Cited by 7
“Cronbach’s alpha for the original scale was approximately 0.90 (Soldatos et al., 2000), while the translated Chinese version was 0.70 (Lin and Yang, 2019).”
InfluentialBatzikosta, A., Μoraitou, D., Steiropoulos, P., Παπαντωνίου, Γ., Kougioumtzis, G. Α., Katsouri, I.-G., Sofologi, M., & Tsolaki, M. (2024) · Brain Sciences · doi:10.3390/brainsci14080813 · Cited by 8
“%) for diagnosing insomnia, with a total score of 6 or higher being the optimal cutoff for identifying cases [35].”
BackgroundClosed-Loop Auditory Stimulation (CLAS) During Sleep Augments Language and Discovery Learning
Clark, V. P., Valverde, H. P., Briggs, M. S., Mullins, T. S., Ortiz, J., Pirrung, C. J. H., O’Keeffe, O. S., Hwang, M., Crowley, S., Šarlija, M., et al. (2024) · Brain Sciences · doi:10.3390/brainsci14111138 · Cited by 7
“…and fatigue were assessed using the Owl Lark Self-Test [15], Fatigue Severity Scale [16], Epworth Sleepiness scale [17], Athens Insomnia scale [18], Pittsburgh Sleep Quality Index [19], and Stanford Sleepiness scale [20] All visits included the Karolinska Sleep Diary questionnaire [21] for…”
Circadian Rhythms and Sleep Patterns in Urban Greek Couples
Lee, K. A., Beyene, Y., Paparrigopoulos, T. J., Dikeos, D. G., & Soldatos, C. R. (2007) · Biological Research For Nursing · doi:10.1177/1099800407303742 · Cited by 7
“Because it was developed and tested in a Greek sample, the AIS was selected over other potential insomnia measures (Soldatos et al., 2000).”
Wang, Y., Liu, Y., Xi, Z., Yu, Y., Liu, L., Mao, J., Xiao, L., Gu, X., Yao, M., Cui, X., et al. (2019) · Medicine · doi:10.1097/md.0000000000014888 · Cited by 7
Stergiannis, P. I., Govari, M., Jahaj, E., Marvaki, C., Toulia, G., Marvaki, K., Chasioti, G., & Intas, G. (2020) · Advances in experimental medicine and biology · doi:10.1007/978-3-030-32633-3_21 · Cited by 7
Exploding Head Syndrome Accompanied by Repeating Panic Attacks: A Case Report
Kaneko, Y., Kawae, A., Saitoh, K., Gon, Y., Uchiyama, M., & Suzuki, M. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.613420 · Cited by 7
“She did show symptoms of insomnia, especially poor subjective sleep quality, based on the Japanese version of the Athens Insomnia Scale (3), with a score of 10 points [range: 0–24 points, a cutoff score ≥8 indicates insomnia (4)].”
MethodMokros, Ł., Januszczak, J., Baka, Ł., Sienkiewicz‐Jarosz, H., & Świtaj, P. (2021) · Postępy Psychiatrii i Neurologii · doi:10.5114/ppn.2021.108473 · Cited by 7
Lavín, P., Nazar, R., Nassim, M., Noble, H. R., Solomonova, E., Dikaios, E., Novák, M., Mucsi, I., Trinh, E., Potes, A., et al. (2021) · Healthcare · doi:10.3390/healthcare9111410 · Cited by 8
“The primary outcome measure was sleep quality measured by the Athens Insomnia Scale (AIS-8) [21] at baseline and 8-week follow-up.”
MethodPachołek, A., Krotos, A., Drwiła, D., Kalarus, Z. F., Piotrowicz, K., Gąsowski, J., & Tomasik, T. (2020) · PubMed Central · Cited by 7
Tanioka, K., Kayaba, M., Tomishima, S., Komada, Y., & Inoue, Y. (2022) · Chronobiology International · doi:10.1080/07420528.2022.2034839 · Cited by 8
“The response options range from 0 to 3 for a total score range of 0–24 points (Soldatos et al. 2000).”
BackgroundFountoulakis, P. N., Terzoudi, A., Tsiptsios, D., Triantafyllis, A. S., Matziridis, A., Leontidou, E., Manolis, A., Tsamakis, K., Ouranidis, A., Steiropoulos, P., et al. (2022) · Sleep Science · doi:10.5935/1984-0063.20220069 · Cited by 7
“According to the Greek versions of Epworth sleepiness scale (ESS), Athens insomnia scale (AIS), Pittsburgh sleep quality index (PSQI) and Berlin questionnaire (BQ) the prevalence of daytime sleepiness was 8.7% (83 subjects), insomnia 18.0% (172 subjects), poor sleep quality 38.5% (368 subjects) and high risk of obstru…”
MethodInfluentialMafla-España, M. A., Torregrosa, M. D., Beamud-Cortés, M., Bermell-Marco, L., Rubio‐Briones, J., & Cauli, O. (2023) · Healthcare · doi:10.3390/healthcare11091266 · Cited by 7
“in 2000 [36] and validated in Spanish by Gómez-Benito et al.”
MethodHara, H., Sugahara, K., Hashimoto, M., Mikuriya, T., Tahara, S., & Yamashita, H. (2014) · Acta Oto-Laryngologica · doi:10.3109/00016489.2013.861926 · Cited by 7
“To evaluate nasal symptoms and sleep quality, we compared patient responses before and after drug administration by using a questionnaire prepared in accordance with the Pittsburgh Sleep Quality Index (PSQI) [9] and Athens Insomnia Scale (AIS) [10] (Figures 1 and 2).”
MethodDevelopment of a scale to assess the diurnal impact of insomnia
Ruiz, C., Guilera, G., & Gómez‐Benito, J. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2011.05.015 · Cited by 7
“For instance, the test–retest reliability of the ESS in a sample ofmedical students was similarly high (α=0.82) (Johns, 1992), while that of the AIS-8was even higher (α=0.89) (Soldatos et al., 2000).”
BackgroundMethodResultInfluentialSuzuki, H., Hibino, H., Inoue, Y., Mikami, A. S., Matsumoto, H., & Mikami, K. (2017) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2017.05.007 · Cited by 7
“Insomnia was assessed using the Athens Insomnia Scale (AIS) (Soldatos et al., 2000).”
MethodHarpham, M. E., Nassar, N., Leung, S., Lainchbury, A., & Shand, A. (2018) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2018.1519537 · Cited by 7
“Postnatal depression screening with the Edinburgh Depression Scale [12] and sleep and fatigue assessment was performed with The Athens Insomnia Scale [13] and visual analog scales.”
MethodValidity and Reliability of the Spanish Version of the Pregnancy-Related Thoughts Scale
Oliva-Pérez, J., Cabrero‐García, J., Cabañero‐Martínez, M. J., Richart‐Martínez, M., & Oliver‐Roig, A. (2019) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2019.07.006 · Cited by 7
Yabe, Y., Hagiwara, Y., Sekiguchi, T., Sugawara, Y., Tsuchiya, M., Yoshida, S., Sogi, Y., Yano, T., Onoki, T., Takahashi, T., et al. (2020) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.251.19 · Cited by 7
Validation of Oximetry for Diagnosing Obstructive Sleep Apnea in a Clinical Setting
Ito, K., Uetsu, M., & Kadotani, H. (2020) · Clocks & Sleep · doi:10.3390/clockssleep2030027 · Cited by 7
“1 BMI: body mass index; 2 ESS: Epworth sleepiness scale; 3 AIS: Athens insomnia scale; 4 PHQ-9, Patient Health Questionnaire-9; 5 REI: respiratory event index; 6 AHI: apnea-hypopnea index.”
MethodInfluentialKałduńska, J., Skonieczna‐Żydecka, K., Ryterská, K., Palma, J., Żwierełło, W., Maciejewska, D., Czerwińska-Rogowska, M., Wolska, A., Stachowska, Z., Budawski, R., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17218092 · Cited by 7
“The 0–3 score scale corresponds to the severity of symptoms that occur at least 3 times a week in the last month [26].”
BackgroundA 5-year Longitudinal Study of Low Back Pain in Survivors of the Great East Japan Earthquake
Yabe, Y., Hagiwara, Y., Sekiguchi, T., Sugawara, Y., Tsuchiya, M., Yoshida, S., Sogi, Y., Onoki, T., Suzuki, K., Takahashi, T., et al. (2020) · Spine · doi:10.1097/brs.0000000000003860 · Cited by 7
Chen, F., Lin, X., Pan, Y., Zeng, X., Zhang, S., Hu, H., Yu, M., & Wu, J. (2021) · PeerJ · doi:10.7717/peerj.11061 · Cited by 7
Ghoroghi, S., Hassan, S. A., & Ayub, A. F. M. (2016) · International Journal of Social Science and Humanity · doi:10.18178/ijssh.2017.v7.810 · Cited by 7
Morita, E., Yanagisawa, M., Ishihara, A., Matsumoto, S., Suzuki, C., Ikeda, Y., Ishitsuka, M., Hori, D., Doki, S., Oi, Y., et al. (2020) · Journal of Wood Science · doi:10.1186/s10086-020-1852-y · Cited by 8
“AIS consists of eight items; for example, one of the eight items is awakenings during the night, which can be graded as 0: no problem, 1: minor problem, 2: considerable problem, or 3: serious problem or did not sleep at all [14].”
Bogan, R., & Turner, J. A. (2007) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.a923 · Cited by 7
“The Athens Insomnia Scale is an 8-item scale that evaluates the severity of insomnia as well as its impact on daytime well being and functional capacity (Soldatos 2000).”
Nishitani, N., & Sakakibara, H. (2010) · The Open Sleep Journal · doi:10.2174/1874620901003010001 · Cited by 7
“Quality of sleep was examined by the Athens Insomnia Scale (AIS) [17], an insomnia scale used internationally.”
BackgroundMethodBelay, A. S., Guangul, M. M., & Asmare, W. N. (2020) · doi:10.21203/rs.3.rs-48073/v1 · Cited by 7
“The total score greater than or equals to 6 indicates insomnia [36, 37].”
BackgroundDemographic predictors of bedtime procrastination in the Japanese population
Miyagawa, S., Sato, T., & Maeda, S. (2024) · Sleep and Biological Rhythms · doi:10.1007/s41105-023-00508-7 · Cited by 9
“The Athens Insomnia Scale [29] was used to evaluate sleep quality at least three times a week during the past month.”
MethodTanji, F., Nanbu, H., Nishimoto, D., & Kawajiri, M. (2025) · American Journal of Men s Health · doi:10.1177/15579883241312836 · Cited by 7
Cullen, M., McCrory, S., Hooman, G., Coyle, M., & Fleming, L. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70058 · Cited by 5
Metadata
- Authors
- Soldatos, C. R., Dikeos, D. G., & Paparrigopoulos, T. J.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- Corresponding author
- Soldatos, Constantin R
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2000-06
- Volume
- 48
- Issue
- 6
- Pages
- 555-560
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2021553431
- Cited by
- 1,754
- References
- 34
- Citations by year
- 2026: 196 · 2025: 187 · 2024: 194 · 2023: 184 · 2022: 155 · 2021: 174 · 2020: 110 · 2019: 89 · 2018: 69 · 2017: 54 · 2016: 54 · 2015: 35 · 2014: 41 · 2013: 30 · 2012: 39
- FWCI
- 5.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- Athens Insomnia Scale, insomnia, sleep disorders, ICD-10 diagnostic criteria, self-report questionnaire, psychometric validation, sleep induction, nocturnal awakenings, sleep quality, daytime sleepiness, psychiatric patients, short-form scale
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Personality Inventory, Psychiatric Status Rating Scales, Psychometrics, Reproducibility of Results, Comorbidity
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